Dr. Roberto Viola was invited to kick off the HPCN Europe '98 Conference, giving evidence of the European Space Agency (ESA) experience in the building up of a telemedical information society. He briefly outlined the future potential and the current limitations of innovative communication technologies, such as satellites, Internet and digital video. Economic factors clearly play a larger role than technical issues in the dissemination of high speed networking. People are interested in content rather than in bits and bytes. Today, telemedicine constitutes one of the most popular frontline applications in dynamic network operation. In this regard, ESA's major concern is to create a synergetic relationship between telemedicine as a humanitarian mission on the one side, and as a commercially sustainable service on the other.
At present, we witness the on-going digitalisation of networks, the increasing use of wireless means, and the growing popularity of satellites. The successful creation of an information society implies the synchronisation of all these events to improve the people's lives. The evolution of high speed networking however depends on the wealth of the nations. Almost 92% of the Internet users are situated in the G7 countries and the population density highly influences the broadband expansion. Fortunately, satellite use is insensitive to the density factor. Still, there exists a grey zone with intense competition. To provide a universal service, it will be necessary to balance policies, according to Dr. Viola.
The Internet challenges relate to infrastructure and affordability. PCs have indeed become much faster than the network traffic. Satellites form a useful alternative since they are able to offer a high data rate, sufficient capacity, a global infrastructure, universal coverage and reach, efficient routing, flexible resource allocation, and high quality against interesting prices. The 26 million satellite dishes in Europe thus provide a potential broadband services access point. Next to this, we notice a growing convergence between the PC and the TV, allowing push technologies and high speed services to be implemented. The force of Internet exactly lies in push technologies, pull facilities for people to pull out what they want, and in real time services. The latter two cannot be offered by satellite use up till now.
ESA has developed some interesting projects in this field. The geostationary processor Skyplex provides individual and independent satellite access because there is no real master in the game from the providers' side. New frequency geostationary systems promise Asynchronous Transfer Mode (ATM) and Internet Protocol (IP) in real time. Thirdly, Teledesic is composed of interconnected satellites in lower orbit for services offered by a limited group of shareholders. In spite of the enormous possibilities, this might be a scary concept to some people because of the "Big Brother is watching you" effect.
A very practical use of these novel communication means is telemedicine. Although the concept still doesn't ring too many bells and for a great deal is experimental yet, the potential should be enormous, once organised in an economically viable way and benchmarked on its effectiveness. One of the major advantages lies in the fact that the hospital infrastructure can be reused many times outside the hospital. Because the treatment cycle accelerates and the average stay in bed decreases, more patients can be helped. Today, three tools are applied in telemedicine, namely digital TV for education, Internet for training, and videoconferencing for face-to-face support. Tomorrow, satellite communication will integrate all of these services.
The demand for telemedicine is situated in two contrasting areas: emergency and humanitarian services for the developing countries on the one hand, and exchange of medical data and economic usability on the other. Dr. Viola strongly believes in reconciling both objectives in a harmonious model. Basically, there exist two scenarios. First comes the early roll out of humanitarian telemedicine, which is dealing with emergencies and tele-consulting without fussing about confidentiality, security and license issues. This type will evolve to a mature and self-supportive service of multiclient centres with enhanced security concern, which currently is still a dream.
ESA is one of the main sponsors of satellite based telemedicine. In Bosnia, it has worked together with the Italian military forces to provide a meshed videoconferencing system, IP-communication and three ISDN gateways to the network. Between Milan and Sarajevo, ophthalmic surgery has been applied during the war. Dr. Viola states that evidently this telemedical start had nothing glamorous at all, but surely constituted an affordable one.